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Official Description

Application of cylinder cast (thigh to ankle)

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 29365 involves the application of a cylinder cast, commonly referred to as a stovepipe cast, which extends from the thigh down to the ankle. This type of cast is specifically utilized for the immobilization of fractures, particularly those affecting the patella (kneecap) and certain fractures located in the distal femur (the lower part of the thigh bone). The casting process begins with the application of a stockinette, which serves as a protective layer over the skin in the area designated for casting. Following the stockinette, padding is applied to provide cushioning and to enhance comfort for the patient. The next step involves the use of a plaster or fiberglass roll, which is first immersed in water to activate its setting properties. After saturation, any excess water is gently squeezed out to ensure the material is ready for application. The plaster or fiberglass is then carefully wrapped around the leg, typically starting from the distal (far) end and moving towards the proximal (near) end, ensuring that the cast conforms closely to the contours of the leg. Finally, the material is smoothed and molded to achieve a secure fit, which is essential for effective immobilization and support during the healing process.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The application of a cylinder cast (thigh to ankle) is indicated for specific conditions and injuries that require immobilization to promote healing. The following are the primary indications for this procedure:

  • Fractures of the Patella These are breaks in the kneecap that necessitate stabilization to prevent further injury and to facilitate proper healing.
  • Fractures of the Distal Femur This includes certain types of fractures located in the lower part of the thigh bone, which may require immobilization to ensure alignment and support during recovery.

2. Procedure

The procedure for applying a cylinder cast involves several detailed steps to ensure proper immobilization and support for the injured area. The following outlines the procedural steps:

  • Step 1: Preparation of the Area The first step involves preparing the area to be casted. This includes cleaning the skin and ensuring that it is free from any debris or moisture that could affect the adhesion of the cast materials.
  • Step 2: Application of Stockinette A stockinette is then applied over the area that will be casted. This protective layer serves to shield the skin from direct contact with the casting material, reducing the risk of irritation or injury.
  • Step 3: Padding Application After the stockinette, padding is placed over the stockinette. This padding is crucial as it provides additional comfort and protection, helping to cushion the leg and prevent pressure points from the cast.
  • Step 4: Preparation of Casting Material A plaster or fiberglass roll is then prepared by immersing it in water. This step activates the setting properties of the material, making it pliable for application. Excess water is gently squeezed out to ensure that the material is not overly saturated.
  • Step 5: Application of the Cast The saturated plaster or fiberglass is wrapped around the leg, starting from the distal aspect (the ankle) and moving towards the proximal aspect (the thigh). This technique ensures that the cast is applied in a manner that provides optimal support and immobilization.
  • Step 6: Molding and Smoothing Once the casting material is in place, it is smoothed and molded to the contours of the leg. This final step is essential for achieving a snug fit, which is necessary for effective immobilization and to prevent movement of the fractured area.

3. Post-Procedure

After the application of the cylinder cast, post-procedure care is essential for ensuring the comfort and safety of the patient. Patients are typically advised to keep the cast dry and to avoid any activities that may put undue stress on the cast. Regular follow-up appointments may be scheduled to monitor the healing process and to make any necessary adjustments to the cast. Patients should also be educated on signs of complications, such as increased pain, swelling, or changes in skin color, which may indicate issues that require immediate medical attention.

Short Descr APPLICATION OF LONG LEG CAST
Medium Descr APPLICATION CYLINDER CAST THIGH ANKLE
Long Descr Application of cylinder cast (thigh to ankle)
Status Code Active Code
Global Days 000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Procedure or Service, Multiple Reduction Applies
ASC Payment Indicator Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P6B - Minor procedures - musculoskeletal
MUE 1
CCS Clinical Classification 214 - Traction, splints, and other wound care
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
RT Right side (used to identify procedures performed on the right side of the body)
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
GC This service has been performed in part by a resident under the direction of a teaching physician
GW Service not related to the hospice patient's terminal condition
KX Requirements specified in the medical policy have been met
LT Left side (used to identify procedures performed on the left side of the body)
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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